The Effect of Methadone on Sexual Function in Men Dependent on Opiates

Fooladi N, et al., J Community Med Public Health Care 2016, 3: 013 DOI: 10.24966/CMPH-1978/100013 HSOA Journal of Community Medicine and Public Health Care

Research Article

There are different modalities for treatment of drug dependence The Effect of Methadone on including detoxification and maintenance treatment. In these modalities, various types of narcotic and non-narcotic drugs are Sexual Function in Men used. Methadone is one of the most widely used narcotic drugs in this field [5]. Methadone is a synthetic compound as an alternative Dependent on Opiates narcotic drug that is prescribed in drug dependence treatment whose Nasim Fooladi2, Roohollah Jirdehi1*, Zahra Mohtasham-Ami- aim is reduction in damage resulted from drug abuse [6]. Methadone ri3 and Fatemeh Pakzad1 maintenance treatment was introduced in 1964 by Vincent Dole and Marie Nyswander making the hypothesis that high doses of 1Guilan University, Rasht, Iran methadone consumption leads to eliminate drug craving and to 2 Mazandaran University of Medical Sciences, Sari, Iran interrupt any kind of euphoria resulted from arbitrary use of 3Guilan University of Medical Sciences, Rasht, Iran drugs by fostering cross tolerance. So, opiates consumers get rid of preoccupation with drug and drug seeking behavior. This in turn, causes they can conduct their energies to more productive ways [7]. Despite there lative safety of long-term methadone has been proved completely, due to lack of complete tolerance induced to some of its Abstract effects, the side effects associated with drug used develops. Some of Sexual dysfunction disorder is one of the most common problems these effects, such as euphoria and drowsiness decrease rapidly in faced by opiates dependent people. Accordingly, the present study the first weeks of treatment, but other effects, such as constipation, examined the effect of methadone maintenance treatment on sexual excessive sweating, decreased sexual desire and sexual dysfunction function in men dependent on opiates before and after 6 months continue or several months after taking medication [8]. of treatment. In this study, a cross-sectional method was used in which 60 married men addicted to drug referring to rehabilitation Sexual dysfunction disorder due to persistent and chronic use of centers in Rasht were selected and evaluated. Initially, the patient’s opiates has been one of the serious problems that drug abusers are demographic data were collected and then, their sexual function facing with [9]. According to the DSM definition, sexual dysfunction before and after treatment was assessed by the international index is a kind of disorder in sexual desire and psychosocial changes that of erectile function. The results showed that erectile function, Impact on the sexual response cycle, cause distress and interpersonal sexual satisfaction and overall sexual satisfaction increased significantly after 6 months of treatment, while the orgasmic function difficulties, and include lack of sexual desire, sexual aversion, of people addicted to opiates decreased significantly during this disorder of sexual stimulation and orgasm, dyspareunia and vaginism period. Overall, results showed an average prevalence of sexual [10]. Sexual dysfunctions in men are inability to have a satisfying sex dysfunction disorder at the beginning of treatment and improvement relationship, including erectile dysfunction, premature ejaculation, of some sexual function components after treatment with delayed ejaculation and retrograde ejaculation [11]. Many studies methadone. have examined the relationship between changes in sexual function, Keywords: Methadone Maintenance Treatment (MMT); Opiates; and drug abuse, and the results suggest that different drugs have Sexual dysfunction disorder different effects on sexual function. The drugs abused affect sexual function in various ways. Many of them with low doses boost sexual Introduction function by reducing or inhibiting anxiety or mood temporary Addiction is one of the most miserable problems of modern boosting, but congestion erection and orgasm and ejaculation societies. Drug abuse disorders and their unpleasant consequences abilities are disrupted with continued use of them [12]. Sexual account for one of the major public health problems throughout the dysfunction disorder resulted from using opiates can be occurred world [1]. Drug dependence is a chronic recurrent disorder whose in all phases of sexual arousal (erection), plateau (phase of sexual onset and persistence are affected by the interaction of genetic, excitement), and orgasm (ejaculation) in the sexual responses cycle psychological, social and environmental factors. Addiction not only [13]. In addition, study by [14] found sexual dysfunction could cause leads to severe and profound damages to individuals’ mental and relapse to drug use in patients who are undergoing detoxification physical health, but also results in social harms, such as divorce, treatment. The issue taken into consideration in various studies in crime and unemployment. Many studies have shown that most other countries is the different remedial effects on sexual function in patients with drug abuse suffer from multiple physical illnesses the treatment of addiction to opiates. The studies by Brown et al., [15], Spring et al., [16], Bliesener et al., [17] and Hanbury et al., [18] showed *Corresponding author: Roohollah Jirdehi, Guilan University, Rasht, Iran, Tel: +98 09112319135; E-mail: [email protected] that there was a difference in sexual dysfunction between after and Citation: Fooladi N, Jirdehi R, Mohtasham-Amiri Z, Pakzad F (2016) The before methadone treatment. On the other hand, evidence indicates Effect of Methadone on Sexual Function in Men Dependent on Opiates. J the relationship between the treatment failure and incidence of sexual Community Med Public Health Care 3: 013. dysfunction that this factor, in turn, leads to reduced compliance in Received: December 10, 2015; Accepted: January 29, 2016; Published: drug dependent patients [19]. Thus, given to the commonness and February 12, 2016 difference in opiate addiction treatment effect on sexual function, as Citation: Fooladi N, Jirdehi R, Mohtasham-Amiri Z, Pakzad F (2016) The Effect of Methadone on Sexual Function in Men Dependent on Opiates. J Community Med Public Health Care 3: 013.

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well as, lack of research in this field, the present study was conducted MMT. The results showed that the orgasmic function after MMT in order to examine sexual dysfunction in drug addicts in receiving decreased significantly (p<0.05). MMT. At the beginning of treatment and after 6 month of treatment, Methods mean score on sexual desire was 6.35 and 6.30, respectively, indicating that there is no significant difference among sexual desire of people in The present study was cross-sectional. The statistical population the two times (p>0.05). included all male addicts treated with MMT in remedial centers of drug dependence and abuse in Rasht in 1393 (Persian date) (2014). The subject’s sexual satisfaction means score at the beginning of The study statistical sample included 60 addict persons that referred treatment and after 6 months of MMT was 9.08 and 9.88, respectively. to addiction remedial center of Tavallodino in Rasht that were under The study’s results showed that sexual satisfaction increased MMT. Study inclusion criteria included being male and married, significantly after treatment (p<0.05). history of drug dependency, undergoing MMT, absence of organic At the beginning of treatment and after 6 months of MMT, overall disease affecting sexual function and not taking any medication sexual satisfaction scores mean of the subjects was 7.26 and 8.28, affecting sexual function. The subjects were evaluated during a respectively. The analysis results showed that overall sexual 6-month period (the first and second measurement was conducted satisfaction significantly increased after treatment (p<0.01). at the beginning of treatment and 6 months afterwards, respectively). Discussion Demographic questionnaire and International Index of Erectile The present study aimed at evaluating sexual dysfunction in men Function (IIEF) questionnaire were used for collecting data which had using drug sat the beginning of treatment and 6 months after wards. 15 questions designed by Rosen, Alth of and Giuliano, and measures The study results showed that the severity of some aspects related to five main areas of sexual function including orgasmic function, sexual sexual dysfunction reduced among patients using drugs after MMT. desire, erectile function, intercourse satisfaction and overall This can be related to gradual effects of methadone on the sexual satisfaction of individuals. The maximum score of erectile dysfunction hormones system during treatment which is supporting that the is 30 (while the highest score in the evaluation of orgasmic pharmacokinetic properties of methadone lead to adaptation and dysfunction was 10, sexual satisfaction 15 and overall sexual normalization of the endocrine system and body neuroendocrine satisfaction 10). The test was based on the Likert rating scale. function [20]. Results The results also showed that erection problems during the use of The study included 60 married men who were under MMT. The MMT were moderate that reached mild level after receiving MMT. subjects were between 26 and 47 years old with mean of 32.46 years. This result was consistent with Hallinan et al., [8] and Babakhanian et Pre-treatment drug using duration was 5-19 years with mean of 11.46 al., [9] investigating that the erectile dysfunction in opiates addict men years. under MMT and showed that these patients had a serious impairment in erectile function and treatment with methadone was effective T-test was used for inference about each subscale of sexual significantly in reducing their erectile dysfunction. Although the function at the beginning of treatment and after treatment. The results improvement in erectile function among participants in the study can are shown in table 1. As it can be seen in the table 1, the mean of the be obtained from direct effect of methadone, however, further studies subjects erectile function at the beginning of the treatment was18.50, are required to develop a precise causal relationship. The mentioned representing the average prevalence of this problem in the subjects results contrasted with Roshanpajhu et al., [12] that studied the effect at that time. At the end of 6 months of treatment, erectile function of MMT on sexual function in men dependent on opiates and showed increased to 23.33. The results analysis indicated that erectile function there was no significant difference in erectile function of patients following MMT improved significantly (p<0.01). taking medication between before and after treatment. Mean orgasmic function of the subjects at the beginning of Also, the study showed that there was significant difference in treatment and after six months of methadone treatment was 7.86 subjects orgasmic function between before and after treatment, so and 7.10, respectively, indicating a decline of orgasmic function after that orgasmic function before treatment was higher than after it.

Subscales Sig Samples Number Mean Deviation Standard Deviation T Df

Before treatment 60 18.50 3.27 Erectile function -7.62 59 0 After treatment 60 23.33 4.16

Before treatment 60 7.86 1.75 Orgasmic function 3.28 59 0.002 After treatment 60 7.10 1.73

Before treatment 60 6.35 1.68 Sexual desire 0.30 59 0.76 After treatment 60 6.30 0.96

Before treatment 60 9.08 2.10 Sexual satisfaction -2.37 59 0.02 After treatment 60 9.88 1.73

Before treatment 60 7.26 1.32 Overall satisfaction -6.72 59 0 After treatment 60 8.28 1.23

Table 1: Sexual function scores of the subject before and after treatment.

Volume 3 • Issue 1 • 100013 J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal DOI: 10.24966/CMPH-1978/100013 Citation: Fooladi N, Jirdehi R, Mohtasham-Amiri Z, Pakzad F (2016) The Effect of Methadone on Sexual Function in Men Dependent on Opiates. J Community Med Public Health Care 3: 013.

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Palha et al., [21] investigating sexual function in 101 patients 4. Khademi A, Alleyassin A, Amini M, Ghaemi M (2008) Evaluation of sexual dependent on heroin also showed that 60% of the patients had dysfunction prevalence in infertile couples. J Sex Med 5: 1402-1410. problems in reaching orgasm. After methadone treatment, orgasmic 5. Purnaghash Tehrani S (2009) The comparison of effectiveness of MMT and function in these people came down, indicating a decrease in MD on anxiety and depression signals in drug abuse persons. Journal of methadone effectiveness or increase in opiates on increasing orgasmic Psychological Studies 4: 81-100. performance of people. 6. Kheirabadi, Reza G, Salehi, Mehrdad, Golafshan, et al. (2012) Sexual Dys- In this study, there was no difference in sexual desire between function of Men on Methadone Maintenance Treatment MMT and Its, Rela- before and after treatment, reflecting the fact that methadone taking tion with Methadone Dose and Blood Level of Testosterone and Prolactine. does not make a major change in sexual desire, although it somewhat Medical Journal of Tabriz University of Medical Sciences & Healt 34: 68-73. decreased. Accordingly, Teusch et al., [22] examined the patterns of 7. Kaplan HI, Saddock BJ, Grebb JA (1999) Comprehensive textbook of psy- sexual dysfunction in schizophrenic, neurotic patients, and patients chiatry. (7thedn), Lippincott Williams & Wilkins, Philadelphia, USA. Pg: 1055- receiving MMT and showed that patients taking methadone had 1057. decreased sexual desire, with this reason that it may be caused by 8. Hallinan R, Byrne A, Agho K, McMahon C, Tynan P, et al. ( 2008 ) Erectile methadone and reduced serum testosterone levels. dysfunction in men receiving methadone and buprenorphine maintenance On the other hand, the present study showed there was significant treatment. J Sex Med 5: 684-692. difference in sexual satisfaction and overall satisfaction of patients 9. Babakhanian M, Eqlima, Rahbar G (2011) A preliminary study on sexual receiving MMT before and after initiating it, and it seems that the use functioning disorders among men with opiates abuse, methadone mainte- of methadone led to remarkable increase both in sexual satisfaction nance therapy. Journal of Social Sciences 5: 86-98. and patient’s overall satisfaction. In addition to methadone effect, psychological interventions, educating mental skills and lifestyle 10. Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, et al. (2000) Report of the international consensus development conference on female sexual changes during treatment can improve interpersonal relationships dysfunction: definitions and classifications. J Urol 163: 888-893. and quality of life. This leads to a significant increase in sexual and overall satisfaction. 11. Nikoobakht M (2003) Sexual disorders in men and women. Tehran University of Medical Sciences, Tehran, Iran. Conclusion 12. Roshanpajhu M, Khodaei MR, Tafi E, Rezaei O, Nazeri-Astaneh A, et al. Overall, the results indicate that erectile function, sexual (2012) The Effect of Methadone on Sexual Function in Male Dependent to satisfaction and overall satisfaction of the subjects increased Opiates: Special Issue Addiction Researches 12: 65-71. significantly after treatment with methadone and orgasmic function 13. Quaglio G, Lugoboni F, Pattaro C, Melara B, G.I.C.S, et al. (2008) Erectile decreased significantly. Also, the results showed that no significant dysfunction in male heroin users, receiving methadone and buprenorphine difference observed among the subjects sexual desire. However, maintenance treatment. Drug Alcohol Depend 94: 12-18. having sexual disorders might be associated with many reasons other than addiction, therefore it is hard to conclude that Methadone intake 14. Patel K, Hellstrom WJ (2009) Central regulation of ejaculation and the thera- peutic role of serotonergic agents in premature ejaculation. Curr Opin Investig would result in sexual disorders in addicts. Further research has to be Drugs 10: 681-690. done on this issue by controlling variables such as drug usage history, previous sexual experience, income, education and living standards. 15. Brown R, Balousek S, Mundt M, Fleming M (2005) Methadone maintenance and male sexual dysfunction. J Addict Dis 24: 91-106. Limitations 16. Spring WD Jr, Willenbring ML, Maddux TL (1992) Sexual dysfunction and The study limitations are as follows: low volume of the sample, psychological distress in methadone maintenance. Int J Addict 27: 1325- being single sex of the sample, ignoring age as a factor affecting sexual 1334. function and only paying attention to the patient saying that should be considered in generalizing the results. 17. Bliesener N, Albrecht S, Schwager A, Weckbecker K, Lichtermann D, et al. (2005) Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab 90: 203- Acknowledgement 206. We appreciate all the participants in this study, therapists and 18. Hanbury R, Cohen M, Stimmel B (1977) Adequacy of sexual performance in colleagues of dependency and drug abuse treatment center of men maintained on methadone. Am J Drug Alcohol Abuse 4: 13-20. Tavallodino. 19. 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Volume 3 • Issue 1 • 100013 J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal DOI: 10.24966/CMPH-1978/100013